High Incidence of Tuberculosis in Young Children Living With HIV in the Western Cape, South Africa.

BACKGROUND

Data on tuberculosis (TB) incidence and risk factors among children living with HIV (CLHIV) in the universal ART era are limited.

METHODS

We analyzed routinely collected data on TB diagnoses for CLHIV age ≤5 years, born 2018-2022, in the Westen Cape, South Africa. We examined factors associated with TB diagnosis, with death and loss to follow-up as competing events.

RESULTS

Among 2219 CLHIV, 30% were diagnosed with HIV at birth. Median follow-up from birth was 38 months [interquartile range (IQR: 24-50); 90% started antiretroviral therapy (ART). TB was diagnosed in 28% of CLHIV (n = 626/2219); 62% were first diagnosed before/within 3 months of ART start ("TB before ART") and 38% >3 months after ART start ("TB after ART"). Of those with "TB before ART" (n = 390), median age at HIV diagnosis was 13 months (IQR: 6-22); median time between HIV and TB diagnoses was 5 days (IQR: 0-31). "TB before ART" was associated with older age at HIV diagnosis and advanced/severe immunodeficiency. Of those with "TB after ART" (n = 258), median age at HIV diagnosis was 2 months (IQR: 0-8) and median time from ART start to TB diagnosis was 12 months (IQR: 7-21). "TB after ART" was associated with increased viral load and advanced/severe immunosuppression (time updated). Overall, 5% (n = 112/2219) of CLHIV died, 36% of whom were diagnosed with TB (median time from TB diagnosis to death: 58 days; IQR: 17-191).

CONCLUSIONS

Young CLHIV in this setting have high TB-associated morbidity and mortality. Efforts to improve early HIV and TB diagnosis, viral suppression, and TB preventive therapy are needed.